We didn’t know. The receptionists said that if you ask a patient, “Is it urgent?” they all say yes, it’s really urgent.
The doctors said, “Ha ha, most of it is not urgent. Only this morning, I had a patient…”
You know the story. The anecdotes are always mildly amusing, but we prefer evidence. We couldn’t find any so we built a system which would gather evidence. The method is simple: there’s an online form for the GP to complete after every patient encounter, for a week. One of the questions says:
- Routine – not time critical
- Urgent – assess today
- Emergency – see within the hour
Here is the state of play after n=27,794 submissions over 2 years.
The tiny red bar on the right hand side is Emergency, 122 occasions and just 0.4% or 1 in 250 calls to a GP, in the view of the GP. So it does happen, but not very often.
What does this mean? 3/4 of GP demand is clinically routine, 1/4 is clinically urgent, and 1/250 is emergency. This says little about patients’ perception of urgent. Patients may say it’s urgent because simply to them, it is, or because they feel they need to say so in order to get in. Another mistake by patients, of unknown frequency, is failure to recognise symptoms which may be urgent or indeed life-threatening emergencies, which they would rather brush off. This is why we believe all demand should be treated with respect.
See also “Slaying the dragon myth: an ethnographic study of receptionists in UK general practice” BJGP March 2013, describing the pressures on receptionists, the difficult decisions they make on limited information and with little power.